Trauma Informed Care:

Transcription

1 Trauma Informed Care: The Benefits of Clinical Integration and Organizational Buy-In Speakers: Karen Hill, PhD, MSN, ANP-C, Senior Consultant, Laurie Lockert, MS, LPC, Senior Consultant, Jeffrey Ring, PhD, Principal, June 8, 2016 HealthManagement.com

2 HealthManagement.com

3 HealthManagement.com

4 HealthManagement.com

5 Trauma Informed Care Karen Hill, PhD, MSN, ANP-C Senior Consultant Laurie Lockert, MS, LPC Senior Consultant Jeffrey Ring, Ph.D. Principal 5

6 Objectives Understand organizational imperatives for trauma-informed care delivery Appreciate how TIC dovetails with broader culturally-responsive care management Understand the ROI for embracing trauma informed approaches in patient attrition, job satisfaction and staff productivity Learn how to provide training and support for TIC initiatives 6

7 Overview of Previous Webinar 7

8 Trauma Informed Services Trauma-informed services take into account an understanding of trauma in all aspects of service delivery and place priority on the individual s safety, choice, and control. Such services create a treatment culture of nonviolence, learning, and collaboration Utilizing a trauma-informed approach does not require disclosure of trauma. Rather, services are provided in ways that recognize the need for physical and emotional safety, as well as choice and control in decisions affecting one s treatment. Trauma informed practice is more about the overall essence of the approach, or way of being in the relationship, than a specific treatment strategy or method. Trauma informed practice guide BC Provincial Use Planning Council 8

9 Defining Trauma Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual s functioning and mental, physical, social, emotional, or spiritual well-being. SAMHSA (Substance Abuse and Mental Health Administration) 9

10 The Sufferings of Childhood Can Shape, and Misshape, the Life of an Adult 10

11 Adverse Childhood Experiences Kaiser and CDC Study ACEs are common 2 out 3 had at least 1 ACE 1 was 87% predictive of at least and 50% >3 Women were 50% more likely than men to have scores >5 11

12 Mind and Body 12

13 Who is at Risk? Jailed institutionalized Unborn, babies, children, youth women Elderly, LQBRQ, ethnic, racial minorities Homeless, Low SES chronic illness Mentally ill, Sub users, disabled, Veterans 13

14 Trying to implement trauma-specific clinical practices without first implementing trauma-informed organizational culture change is like throwing seeds on dry land. Sandra Bloom, MD 14

15 Safety Trauma Informed Approach (SAMHSA) Trustworthiness and Transparency Peer Support Collaboration and Mutuality Empowerment: Voice and Choice Cultural, Historical and Gender Issues 15

16 Why Embrace Universal Precautions? Safety Do No Harm Quality Patient Satisfaction Enhanced Outcomes Health Inequities CLAS Standards Compassion Social Justice Practitioner Satisfaction Practice Development 16

17 Trauma-Informed Care, Patient- Centered Care and Culturally Responsive Care TIC PCC CRC 17

18 TRAUMA INFORMED SYSTEMS OF CARE THE ORGANIZATIONAL PATIENT & WORKER SAFETY IMPERATIVE 18

19 TIC Road to Achieving Triple Aim Goals Improve client health outcomes Improve client experience and satisfaction Reduce costs Requires an engaged, trained, supported and satisfied workforce Primary, secondary trauma leads to chronic stress, de-motivation workforce and withdrawal 19

20 Chronic Workplace Stress 1 st U.S. Workforce issue Fatigue Chronic pain Diabetes Obesity Heart disease Substance use Tower, Watson Survey,

21 Trauma-Related Workplace Stress Difficulty leaving work behind at the end of the day Lack of resources to do the work Need for system change Struggling with service provider-client relationship dynamics Difficulty meeting expectations Exposure to primary, secondary trauma, suicide, homicide Feeling ineffective or powerless to help the client Not getting enough money Different philosophies between staff members, even in the same department 21

22 Workforce Withdrawal Behaviors Lateness or tardiness not arriving on time to work lateness to work is a good predictor of job withdrawal (Adler & Golan,1981) 22

23 Workforce Withdrawal Behaviors Presenteeism Phenomenon of coming to work yet not functioning up to their capacity mistakes, poor quality, tasks take longer, impaired social functioning 60% of worker reported decreased productivity due to workplace stress Costs organizations $168 billion annually in lost productivity 23

24 Workforce Withdrawal Behaviors Absenteeism: an employee s intentional or habitual absence from work Cost organizations $84 billion Annually unscheduled absences cost $2,600 to $3,500 per employee Causes: bullied, harassment burnout, stress, morale or disengaged family burden depression, illness, injury 24

25 Workforce Withdrawal Behaviors Burnout: a reaction to elongated periods of emotional and interpersonal stressors on the job In a Canadian study Dewa et al 2014 report $213 million related to PCP early retirement and reduced hrs. mental health, job satisfaction, and quality of care sick time, intent to leave medicine and job changes 25

26 Workforce Withdrawal Behaviors Turnover: number of staff who leave and are replaced Takes about 10 months for organization to recover and longer if leadership leaves $3,500 to replace a one 8hr employee with recruitment, training etc. High earners 2x annual salary or 6-9 months or monthly Society for human resource management (2016) 26

27 TIC Workforce and Burnout Handran (2015) reported that healthcare workers with high need populations were less likely to report burnout and compassion fatigue in TIC organizations as compared to non TIC organizations 27

28 Workforce Injury and Illness Burden Chronic illness and/or injury Heart disease $1 in every $6 spent Chronic pain 11.6 to 12.7 million Obesity 153 billion Tobacco 1 in 5 deaths injury both fatal, non fatal and near-misses 28

29 Organizational Repercussions Poor patient outcomes Poor employee outcomes Lost revenue Increased costs Risk to organization viability Billions of dollars spent 29

30 What s the Organization ROI? Organizational mission, goals and objectives met Improved workplace health and safety outcomes Stability of workforce Improved satisfaction scores Improved patient outcomes Improvement in bottom line 30

31 BlueCross BlueShield Tennessee Case Studies Surveyed employees and 42 percent showed moderate to severe levels of stress. They piloted a stress management program in partnership with Boulder Creek, California-based HeartMath. Results: A decrease in exhaustion a hallmark symptom of stress. The company estimated it could save $2 million annually in healthcare costs from instituting the program in all locations. Delnor Community Hospital, located near Chicago, found that stress management strategies reduced employee turnover from 28 percent down to nearly 21 percent in two years, saving the hospital nearly $800,

32 Supporting Your Trauma Informed Care Initiative Organizational Practices Clinical Practices Trainings 32

33 Ideas Don t Change the Culture- People Change the Culture Missteps along the way 33

34 Organizations are People Too Can be traumatized Chronic stress Acute stress Resist change (even positive change) Resist new leadership Become trauma-organized Reactivity replaces strategy Us/them mentality Loss of communication/gossip Participatory processes break down Interpersonal conflicts erupt and aren t dealt with 34

35 Create the Organizational Change You Want by Starting with the Map 35

36 Addressing Clinical Practices Involve patients in their treatment Screen for trauma Train staff in trauma specific treatments appropriate to the care setting Develop a community referral network for patients needing more treatment help 36

37 Ongoing training opportunities TIC 101 and 102 Secondary trauma and self care Ask for staff input on their training needs and don t forget the 37

38 As the Culture Changes, What You Will See A pediatrician s story 38

39 Keeping It Going Communication and transparency Democracy-everyone has a voice (having a voice is not the same as having a vote, but it is crucially important) Feeling heard Develop a learning organization (increases emotional intelligence) Build community 39

40 Commitment to Act In the chat box, please describe what you intend to do anew or enhanced based on our conversation today. 40

41 References Digest (Dec. 2008). Dewa, C. S., Jacobs, P., Thanh, N. X., & Loong, D. (2014). An estimate of the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada. BMC Health Services Research, 14, Leigh, J.P Economic burden of Occupational Illness in the U.S,, The Milbank Quarterly, Vol. 89, No. 4, 2011 (pp )c 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc. Mercer, & Kronos. (2013). Average of Cost of Absenteeism Graph. Retrieved from AyM&tbnid=oLCyQJHb8GpyQM:&ved=0CAUQjRw&url=http%3A%2F%2Fblog.cleanphirst.com%2F2009_09 _01_archive.html&ei=8whOUdWoFaS80AGgy4GoBg&bvm=bv ,d.dmg&psig=AFQjCNEr Willingham, Jacqueline G. Managing Presenteeism and Disability to Improve Productivity. Benefits & Compensation Issue Brief: Key Ingredients for Successful Trauma-Informed Care Implementation, April 2016, CHCS 41

42 Can Help! Jeffrey Ring, PhD, Principal, Karen Hill, PhD, MSN, ANP-C, Senior Consultant, Laurie Lockert, MS, LPC, Senior Consultant, June 8, 2016 HealthManagement.com